ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2021
Desirability of Outcome Ranking for the Management of Antimicrobial Therapy (DOOR MAT) Reveals Improvements in the Treatment of Bloodstream Infections Caused by Escherichia coli and Klebsiella pneumoniae in Patients from the Veterans Health Administration.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Assessing the feasibility of a platform trial for Gram negative bloodstream infections: results from the vanguard phase of BALANCE.BMJ open · 2025Article
- Article
- Beyond Accuracy: Methodological Advances for Assessing the Clinical Impact of Infectious Disease Diagnostics.Open forum infectious diseases · 2025Article
- Proactive antimicrobial stewardship with real-time microbiological alerts improves management of bloodstream infections.JAC-antimicrobial resistance · 2025Article
- Clinical Outcomes of Early Phenotype-Desirable Antimicrobial Therapy for Enterobacterales Bacteremia.JAMA network open · 2024Article
- Designing clinical trials to address alcohol use and alcohol-associated liver disease: an expert panel Consensus Statement.Nature reviews. Gastroenterology & hepatology · 2024Review
- Simplified Spectrum Score (SScientific reports · 2024Article
- Incidence and variability in receipt of phenotype-desirable antimicrobial therapy for Enterobacterales bloodstream infections among hospitalized United States patients.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Desirability of Outcome Ranking for Status Epilepticus: A Benefit-Risk Approach to Design and Analyses of Clinical SE Trials.Neurology · 2023Article
- Desirability of outcome ranking and quality life measurement for antimicrobial research in organ transplantation.Transplant infectious disease : an official journal of the Transplantation Society · 2022Review
- A case-control study of infections caused byFrontiers in cellular and infection microbiology · 2022Article
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Abstract
backgroundReductions in the use of broad-spectrum antibiotics is a cornerstone of antimicrobial stewardship. We aim to demonstrate use of the Desirability of Outcome Ranking Approach for the Management of Antimicrobial Therapy (DOOR MAT) to evaluate the treatment of Escherichia coli and Klebsiella pneumoniae bloodstream infections in patients from the Veterans Health Administration (VHA) across a decade.
methodsUsing electronic records, we determined empiric and definitive antibiotic treatments, clinical characteristics, and 30-day mortality of patients with monomicrobial E. coli and K. pneumoniae bloodstream infections hospitalized in VHA medical centers from 2009 to 2018. Focusing on patients treated with parenteral β-lactams and with available antibiotic susceptibility testing results, we applied a range of DOOR MAT scores that reflect the desirability of antibiotic choices according to spectrum and activity against individual isolates. We report trends in resistance and desirability of empiric and definitive antibiotic treatments.
resultsDuring the 10-year period analyzed, resistance to expanded-spectrum cephalosporins and fluoroquinolones increased in E. coli but not in K. pneumoniae, while resistance to carbapenems and piperacillin-tazobactam remained unchanged. In 6451 cases analyzed, we observed improvements in DOOR MAT scores consistent with deescalation. Improvement in desirability of definitive treatment compared with empiric treatment occurred in 26% of cases, increasing from 16% in 2009 to 34% in 2018. Reductions in overtreatment were sustained and without negative impact on survival.
conclusionsDOOR MAT provides a framework to assess antibiotic treatment of E. coli and K. pneumoniae bloodstream infections and can be a useful metric in antimicrobial stewardship.
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